Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department

Publication Date: September 1, 2015

Recommendations

Patient Management

With a goal to improve functional outcomes, IV tPA should be offered and may be given to selected patients with acute ischemic stroke within 3 hours after symptom onset at institutions where systems are in place to safely administer the medication. The increased risk of symptomatic intracerebral hemorrhage (sICH) should be considered when deciding whether to administer IV tPA to patients with acute ischemic stroke. (B)
325320
When feasible, shared decisionmaking between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer IV tPA for acute ischemic stroke. (C)
(Consensus recommendation)
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When feasible, shared decisionmaking between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer IV tPA for acute ischemic stroke. (C)
(Consensus recommendation)
325320
Despite the known risk of sICH and the variability in the degree of benefit in functional outcomes, IV tPA may be offered and may be given to carefully selected patients with acute ischemic stroke within 3 to 4.5 hours after symptom onset at institutions where systems are in place to safely administer the medication. (B)
325320

Recommendation Grading

Disclaimer

Overview

Title

Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department

Authoring Organization

Publication Month/Year

September 1, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This clinical policy from the American College of Emergency Physicians is the revision of a clinical policy approved in 2012 addressing critical questions in the evaluation and management of patients with acute ischemic stroke

Target Patient Population

Patients with acute ischemic stroke

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Emergency care

Intended Users

Paramedic emt, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D020521 - Stroke, D002545 - Brain Ischemia, D010960 - Plasminogen Activators, D010959 - Tissue Plasminogen Activator

Keywords

Acute Ischemic Stroke, t-pa, plasminogen activator

Source Citation

Ann Emerg Med. 2015;66:322-333.

Methodology

Number of Source Documents
100
Literature Search Start Date
January 1, 2011
Literature Search End Date
September 3, 2014